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McMahon C, Hammarberg K, Lensen S, Wang R, Mol BW, Vollenhoven BJN. What do women undergoing in vitro fertilization (IVF) understand about their chance of IVF success? Hum Reprod 2024; 39:130-138. [PMID: 37976406 PMCID: PMC10767958 DOI: 10.1093/humrep/dead239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 09/19/2023] [Indexed: 11/19/2023] Open
Abstract
STUDY QUESTION How well informed are Australian women who undergo IVF about their chances of having a baby? SUMMARY ANSWER Only one in four women estimated their individual chance of success with IVF accurately, with most women overestimating their chance. WHAT IS KNOWN ALREADY Limited knowledge about infertility and infertility treatment in the general population is well-documented. The few studies that have investigated patients' knowledge about the chance of IVF success suggest that while IVF patients are aware of average success rates, they tend to be unrealistic about their own chance of success. STUDY DESIGN, SIZE, DURATION We conducted an anonymous online survey of 217 women who had started IVF since 2018 in Australia. The survey was advertised on social media, enabling women from across Australia to participate. Responses were collected in June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS The survey included questions on demographic characteristics and IVF history. It asked what participants thought their chance of having a baby from one IVF treatment cycle was, how they rated their knowledge about chance of success, and about their experience of receiving IVF-related information. Participants' estimations of their chance of success were compared with their chance as calculated by the Society for Assisted Reproductive Technology's (SART) online calculator. Responses to a free-text question about what information women wished they had been given when they started treatment were analysed thematically. MAIN RESULTS AND THE ROLE OF CHANCE Only about a quarter (58/217, 27%) of participants accurately estimated their chance of having a baby within 20% relative to their SART calculated chance, with more than half (118/217, 54%) overestimating their chance. Ninety percent of women indicated that their preferred source of treatment information was a consultation with their doctor, despite less than half (44%) reporting that doctors explained the probability of having a baby with IVF well (mean 5.9/10). In free-text responses, many women also reported that they wished they had been given more realistic information about IVF and their chance of success. LIMITATIONS, REASONS FOR CAUTION The dissemination method precludes calculation of response rate, and it is not possible to know if participants are representative of all women undergoing IVF. Additionally, we only surveyed women undergoing IVF, while those who decided not to have IVF were not included. Therefore, women who overestimated their chance may have been overrepresented. There is also inherent imprecision in the way understanding of chance of success was estimated. The potential impact of recall bias could neither be quantified nor excluded. It is difficult to determine to what extent women's lack of understanding of what is possible with IVF is due to poor information-provision by clinicians and the clinic, and how much can be explained by optimism bias. WIDER IMPLICATIONS OF THE FINDINGS The finding of poor understanding of personal chance of success amongst women undergoing IVF in Australia requires further investigation to determine potential reasons for this. The findings can be used by clinics to develop strategies for improvement in the information-provision process to ensure that women can make informed decisions about their fertility treatment. STUDY FUNDING/COMPETING INTEREST(S) This study received no external funding. S.L. is supported by a NHMRC Investigator Grant (APP1195189). R.W. is supported by a NHMRC Investigator Grant (APP2009767). B.W.M. is supported by a NHMRC Investigator Grant (GNT1176437). B.W.M. reports consultancy for Merck and ObsEva and has received research funding and travel funding from Merck. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- C McMahon
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia
| | - K Hammarberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Victorian Assisted Reproductive Treatment Authority (VARTA), Melbourne, VIC, Australia
| | - S Lensen
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - R Wang
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia
| | - B W Mol
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia
- Aberdeen Centre for Women’s Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Women’s and Newborn Program, Monash Health, Melbourne, VIC, Australia
| | - B J N Vollenhoven
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, VIC, Australia
- Monash IVF, Melbourne, VIC, Australia
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Wang A, Anderson-Bialis J, Morris JR, Corley J, Anderson-Bialis D, Citro L, Seegulam ME, Fujimoto V. Racial and ethnic differences in self-reported satisfaction with fertility clinics and doctors. Arch Gynecol Obstet 2023; 308:239-253. [PMID: 37072582 DOI: 10.1007/s00404-023-07043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To investigate if differences in self-reported satisfaction with fertility clinics and doctors differ by race/ethnicity. STUDY DESIGN We used cross-sectional survey data from FertilityIQ online questionnaires completed by patients receiving US. fertility care from July 2015 to December 2020. Univariate and multivariate logistic and linear regression analyses were performed to assess association of race/ethnicity on patient-reported clinic and physician satisfaction. RESULTS Our total sample size included 21,472 unique survey responses (15,986 Caucasian, 1856 Black, 1780 LatinX, 771 East Asian, 619 South Asian, 273 Middle Eastern, 187 Native American self-reported). When adjusting for potential confounders (demographic and patient satisfaction), we found that Black patients rated their doctors more highly (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.04-1.62 p = 0.022 logistic and Coefficient 0.082, 95% CI 0.013-0.15 p = 0.02 linear), while other ethnic groups did not show significant differences compared to Caucasian patients. East Asians had borderline lower satisfaction with clinic satisfaction in logistic regression (OR 0.74 95% CI 0.55-1.00 p = 0.05), while significant differences were not found for other ethnic groups for clinic satisfaction. CONCLUSIONS In summary, some but not all minority groups differed in their self-reported perception of satisfaction with fertility clinic and doctors compared to Caucasian patients. Cultural differences towards surveys may contribute to some of these findings, and satisfaction by racial/ethnic group may also be modified by results of care.
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Affiliation(s)
- Ange Wang
- Division of Reproductive Endocrinology and Infertility, University of California, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA.
| | | | - Jerrine R Morris
- Division of Reproductive Endocrinology and Infertility, University of California, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Jamie Corley
- Division of Reproductive Endocrinology and Infertility, University of California, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | | | | | | | - Victor Fujimoto
- Division of Reproductive Endocrinology and Infertility, University of California, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
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ŞAHİNER P, ŞEHİRALTI M. Informed Consent of Couples in IVF Practices: A Limited Study in Turkey. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2023. [DOI: 10.30934/kusbed.1132624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: The aim of this study is to obtain informed consent in vitro fertilization applications and to determine the factors affecting this process.
Methods: This article is a full-text original research article. Descriptive and cross-sectional study was conducted with 193 women and 54 men, undergoing in vitro fertilization treatment. Study form consisted of questions regarding sociodemographic features and informed consent. The form was filled on the day the eggs were collected. The ethical committee approved the protocol of the study and all participants were provided with verbal informed consent.
Results: According to result of the study, it was found that more than one third (38.5%) of the participants were not informed verbally, 34.1% of those who were informed could not understand what was told. Those who applied to a private physician were more informed. The explanations were not understood mainly due to the problems arising from informing process. The consent form was given to all participants after starting treatment. Two thirds of the participants read the consent form and 22.7% of them did not understand what they read. Almost half (41.3%) of those who did not read the consent form stated that they consider the reading and signing the form as a procedure for the implementation of the transaction. Those who had time to read the consent form read more (p<0.001) and understood more (p=0.036).
Conclusion: In this study, it was concluded that there were problems with the transferring and understanding of information, and that valid consents were not taken from some patients.
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Affiliation(s)
- Pervin ŞAHİNER
- KOCAELİ ÜNİVERSİTESİ, KOCAELİ SAĞLIK YÜKSEKOKULU, EBELİK BÖLÜMÜ, EBELİK PR
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Skedgel C, Ralphs E, Finn E, Markert M, Samuelsen C, Whitty JA. How Do People with Experience of Infertility Value Different Aspects of Assistive Reproductive Therapy? Results from a Multi-Country Discrete Choice Experiment. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:459-472. [PMID: 34940935 PMCID: PMC9197909 DOI: 10.1007/s40271-021-00563-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/21/2022]
Abstract
Objectives Assistive reproductive therapies can help those who have difficulty conceiving but different forms of assistive reproductive therapies are associated with different treatment characteristics. We undertook a large, multinational discrete choice experiment to understand patient preferences for assistive reproductive therapies. Methods We administered an online discrete choice experiment with persons who had experience with subfertility or assistive reproductive therapies in the USA, UK, the Nordic region (Denmark, Norway, Sweden, Finland), Spain, and China. Attributes encouraged trade-offs between effectiveness, risk of adverse effects, treatment (dis)comfort, (in)convenience, cost per cycle and shared decision making. We used multinomial logit and mixed-logit models to estimate preferences and attribute importance by country/region, and estimated willingness to pay for changes in attribute levels. Results A total of 7565 respondents participated. Mixed logit had a better fit than multinomial logit across all samples. Preferences moved in expected directions across all samples, but the relative importance of attributes differed between countries. Willingness to pay was greatest for improvements in effectiveness and a greater degree of shared decision making, and we observe a substantial ‘option value’ independent of treatment characteristics. Unexpectedly, preferences over cost were insignificant in the Chinese sample, limiting the use of willingness to pay in this sample. Conclusions Respondents balanced concerns for effectiveness with other considerations, including the cost and (dis)comfort of treatment, and the degree of shared decision making, but there is also substantial option value independent of treatment characteristics, demonstrating value of assistive reproductive therapies to individuals with experience of subfertility. We hypothesise that price insensitivity in the Chinese sample may reflect a degree of social desirability bias. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00563-7.
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Leyser-Whalen O, Bombach B, Mahmoud S, Greil AL. From generalist to specialist: A qualitative study of the perceptions of infertility patients. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:204-215. [PMID: 35036590 PMCID: PMC8753058 DOI: 10.1016/j.rbms.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
Few studies explore in-depth accounts of women's and men's experiences with, and transitions between, obstetrician/gynaecologists (OB/GYNs) and reproductive endocrinologists during infertility diagnostic and treatment processes. This study examined this subject matter with data from qualitative, in-depth, semi-structured interviews. Between April 2007 and March 2008, the first author interviewed 20 women and eight men from a large midwestern metropolitan area in the USA who had used, or were in the process of using, any fertility treatment in the 5 years preceding the interview. Six couples and 16 individuals were interviewed, resulting in narratives of 22 distinct infertility journeys. The main complaints made by respondents about OB/GYNs were that they were insufficiently concerned with providing timely treatment and that they paid insufficient attention to male partners. Women felt that their concerns were taken more seriously by reproductive endocrinologists, but complained of insensitivity, depersonalization and misinformation, and were suspicious of a profit orientation.
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Affiliation(s)
- Ophra Leyser-Whalen
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Brianne Bombach
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Sara Mahmoud
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Arthur L. Greil
- Division of Social Sciences, Alfred University, Alfred, NY, USA
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Webair HH, Ismail TAT, Ismail SB, Khaffaji AJ, Hussain NHN, Kadir AA, Muhamad R, Bakar FAA, Ismail NR, Badri N. Patient-centered infertility questionnaire for female clients (PCIQ-F): part I: questionnaire development. BMC Med Res Methodol 2021; 21:188. [PMID: 34544388 PMCID: PMC8454158 DOI: 10.1186/s12874-021-01376-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-centered care is an essential component of health care quality. To achieve patient-centered care, health care authorities should have a clear definition and an applicable tool to measure the extent of its application. The real concept of patient centeredness should be developed by the patients themselves. We aimed to demonstrate a way to develop a draft Arabic patient-centered infertility care (PCIC) questionnaire for females clients following practical steps that address women with infertility. METHODS An iterative process of questionnaire development was undertaken by combining two approaches: the steps proposed by Robert F. DeVellis for scale development and the recommended practices for questionnaire development and testing in the European statistical system. We attempted to develop the draft questionnaire that involved conceptualization and operationalization, generation of an item pool, development of the questionnaire format, review of the initial item pool by experts, and consideration of validation items for inclusion. RESULTS We generated an item pool from in-depth interviews with 14 women who sought infertility care within 6 months before the interview time. We then added more items from a literature review. The item pool contained 123 items distributed through 10 domains. Ten women with infertility were included for face validation. Then, experts with backgrounds in Obstetrics and Gynecology, Family Medicine, and Public Health reviewed the item pool using content validation (n = 10 professors and/or specialists). The item pool was finally reduced to 57 items. We developed the draft Arabic patient-centered infertility care questionnaire for female clients (PCIQ-F) with three sections, including 66 items: background variables, PCIC experience variables, and a general question about the quality of infertility care in the health facility. The draft questionnaire was further reviewed and edited last by experts in preparation for part 2, which will test the questionnaire and prepare the final version. CONCLUSION The PCIQ-F questionnaire development is a multi-step iterative process started and ended by the target users as experts. Experts' participation in infertility care and in questionnaire format development had a great impact on questionnaire development and conflict resolution. We recommend this transparent and replicable approach for new instrument developers; it is likely to generate a questionnaire that is valid and acceptable to target users. The draft PCIQ-F questionnaire is ready for testing of its psychometric properties before the final version to measure the PCIC level in health facilities.
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Affiliation(s)
- Hana Hasan Webair
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia. .,Department of Family Medicine, Hadhramout University, College of Medicine, PO Box 50512, Mukalla, Hadhramaut, Yemen. .,International Medical Center, Jeddah, Saudi Arabia.
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Shaiful Bahari Ismail
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Azza Jameel Khaffaji
- Obstetrics and Gynaecology Department, Ministry of Health, King Abdulaziz Hospital, P.O.Box 31467, Jeddah, 21497, Saudi Arabia
| | - Nik Hazlina Nik Hussain
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Azidah Abdul Kadir
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | | | - Nur Raihan Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nagwa Badri
- International Medical Center, Jeddah, Saudi Arabia
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Timmers T, Keijsers M, Kremer JAM, Janssen L, Smeenk J. Supporting Women Undergoing IVF Treatment With Timely Patient Information Through an App: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e28104. [PMID: 34448725 PMCID: PMC8433853 DOI: 10.2196/28104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/02/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the introduction of assisted reproductive technologies in 1978, over 2 million in vitro fertilization (IVF) babies have been born worldwide. Patients play a vital role in the success of this treatment. They are required to take fertility medication (hormone injections) to activate the ovaries to produce a sufficient number of oocytes. Later, they need to take medication to increase the chance of the embryo surviving inside the uterus. Patients are educated during an intake consultation at the start of the treatment to minimize the emotional burden and reduce noncompliance. The consultation lasts about 30 to 45 minutes and covers all essential subjects. Even though ample time and energy is spent on patient education, patients still feel anxious, unknowledgeable, and unsupported. As such, electronic health utilizing a smartphone or tablet app can offer additional support, as it allows health care professionals to provide their patients with the correct information at the right time by using push notifications. OBJECTIVE This randomized controlled trial aimed to evaluate the capacity of an app to support IVF patients throughout the different phases of their treatment and assess its effectiveness. The study's primary outcome was to determine the patients' level of satisfaction with the information provided. The secondary outcomes included their level of knowledge, ability to administer the medication, overall experienced quality of the treatment, health care consumption, and app usage. METHODS This study was performed at a specialized fertility clinic of the nonacademic teaching hospital Elisabeth-TweeSteden Ziekenhuis in Tilburg, the Netherlands. Patients who were scheduled for IVF or intracytoplasmic sperm injection treatments between April 2018 and August 2019 were invited to participate in a physician-blinded, randomized controlled trial. RESULTS In total, 54 patients participated (intervention group: n=29). Patients in the intervention group demonstrated a higher level of satisfaction on a 0 to 10 scale (mean 8.43, SD 1.03 vs mean 7.70, SD 0.66; P=.004). In addition, they were more knowledgeable about the different elements of the treatment on a 7 to 35 scale (mean 27.29, SD 2.94 vs mean 23.05, SD 2.76; P<.001). However, the difference disappeared over time. There were no differences between the two patient groups on the other outcomes. In total, 25 patients in the intervention group used the app 1425 times, an average of 57 times per patient. CONCLUSIONS Our study demonstrates that, in comparison with standard patient education, using an app to provide patients with timely information increases their level of satisfaction. Furthermore, using the app leads to a higher level of knowledge about the steps and procedures of IVF treatment. Finally, the app's usage statistics demonstrate patients' informational needs and their willingness to use an electronic health application as part of their treatment. TRIAL REGISTRATION Netherlands Trial Register (NTR) 6959; https://www.trialregister.nl/trial/6959.
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Affiliation(s)
- Thomas Timmers
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Interactive Studios, Rosmalen, Netherlands
| | - Manouk Keijsers
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Jan A M Kremer
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Jesper Smeenk
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
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Martin CE, Lanham M, Almgren-Bell A, Marsh C, Omurtag K. A randomized controlled trial to evaluate the use of a web-based application to manage medications during in vitro fertilization. Fertil Steril 2021; 116:793-800. [PMID: 34016436 DOI: 10.1016/j.fertnstert.2021.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the use of a web-based application that assists in medication management during in vitro fertilization (IVF) treatment. DESIGN Multicenter randomized controlled trial. SETTING University hospitals. PATIENT(S) Women undergoing IVF. INTERVENTION(S) Subjects were recruited to assess quality of life during IVF and were randomly assigned to use either the OnTrack application to assist with medication management or conventional medication management. Surveys were administered at four time points. MAIN OUTCOME MEASURE(S) Medication surplus, incidence of medication errors, amount of patient-initiated communication, and patient satisfaction. RESULT(S) A total of 153 women participated. The average number of portal messages and telephone calls was similar between groups. Twelve patients in the control group (12/69, 17.4%) and 8 patients in the case group (8/72, 11.1%) made medication errors. There were similar amounts of medication surplus in the two groups. The estimated cost of medication waste was $2,578 ± $2,056 in the control group and $2,554 ± $1,855 in the case group. Patient satisfaction was similar between the two groups. CONCLUSION(S) Use of a web-based application did not decrease medication errors, medication surplus, or patient-initiated messages. Many patients had a medication surplus, which can be an area of cost reduction during IVF. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT03383848.
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Affiliation(s)
- Caitlin Elizabeth Martin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
| | - Michael Lanham
- Department of Learning Health Sciences, Michigan Medicine, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | | | - Courtney Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Kansas Health System, Overland Park, Kansas
| | - Kenan Omurtag
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
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Shandley LM, Hipp HS, Anderson-Bialis J, Anderson-Bialis D, Boulet SL, McKenzie LJ, Kawwass JF. Patient-centered care: factors associated with reporting a positive experience at United States fertility clinics. Fertil Steril 2020; 113:797-810. [DOI: 10.1016/j.fertnstert.2019.12.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022]
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Borghi L, Leone D, Poli S, Becattini C, Chelo E, Costa M, De Lauretis L, Ferraretti AP, Filippini C, Giuffrida G, Livi C, Luehwink A, Palermo R, Revelli A, Tomasi G, Tomei F, Vegni E. Patient-centered communication, patient satisfaction, and retention in care in assisted reproductive technology visits. J Assist Reprod Genet 2019; 36:1135-1142. [PMID: 31077010 PMCID: PMC6603100 DOI: 10.1007/s10815-019-01466-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/28/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore the association between patient-centered communication, patients' satisfaction, and retention in care in assisted reproductive technology (ART) visits. METHODS ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary "patient-centered communication" ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3 months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis. RESULTS Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (μ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor's humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians' recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic. CONCLUSIONS Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is "patient-centered" in the ART context might be wider, including the couples' need for information, as suggested by qualitative findings.
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Affiliation(s)
- L Borghi
- Department of Health Sciences, University of Milan, 20142, Milan, Italy.
| | - D Leone
- Department of Health Sciences, University of Milan, 20142, Milan, Italy
- San Paolo University Hospital, Asst-Santi Paolo e Carlo, 20142, Milan, Italy
| | - S Poli
- Department of Health Sciences, University of Milan, 20142, Milan, Italy
| | - C Becattini
- Futura Assisted Reproductive Center, 50129, Florence, Italy
| | - E Chelo
- Demetra Assisted Reproductive Center, 50141, Florence, Italy
| | - M Costa
- Ospedale Evangelico Internazionale, Assisted Reproductive Unit, 16122, Genoa, Italy
| | - L De Lauretis
- Istituto Clinico Città Studi, Assisted Reproductive Center, 20131, Milan, Italy
| | - A P Ferraretti
- S.I.S.Me.R. Reproductive Medicine Unit, 40138, Bologna, Italy
| | - C Filippini
- Department of Surgical Sciences, University of Turin, 10126, Turin, Italy
| | - G Giuffrida
- CRA, Assisted Reproductive center, 95128, Catania, Italy
| | - C Livi
- Demetra Assisted Reproductive Center, 50141, Florence, Italy
| | - A Luehwink
- Azienda Provinciale per i Servizi Sanitari-Provincia Autonoma di Trento, Assisted Reproductive Unit, 38123, Arco, Italy
| | - R Palermo
- Ambra Assisted Reproductive Center, 90138, Palermo, Italy
| | - A Revelli
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, 10126, Torino, Italy
| | - G Tomasi
- CRA, Assisted Reproductive center, 95128, Catania, Italy
| | - F Tomei
- Azienda Ospedaliera Santa Maria degli Angeli, 33170, Pordenone, Italy
| | - E Vegni
- Department of Health Sciences, University of Milan, 20142, Milan, Italy
- San Paolo University Hospital, Asst-Santi Paolo e Carlo, 20142, Milan, Italy
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Yosef L, Soffer M, Malul M. From Welfare to Work and From Work to Welfare: A Comparison of People With and Without Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2018. [DOI: 10.1177/1044207318782674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we explore the behavioral factors that play a role in the decision—among people with and without disabilities—to move from welfare to work and from work to welfare. A survey of people with and without disabilities in Israel was conducted; a nonprobability quota sample of 193 individuals was drawn (95 people with disabilities and 98 nondisabled people). The data were collected by means of a closed-ended questionnaire. The results show that people with disabilities tended more than nondisabled persons to favor decisions that maintain their current employment status quo bias). Furthermore, compared with nondisabled individuals, people with disabilities demanded more wages or benefits while changing status in the labor market. The more years of education people with disabilities have, the less incentive is needed to resume or begin working. In addition, the noneconomic value of work is higher among more-educated people compared with less-educated people with disabilities. The results emphasize the need to design various policies to lower the status quo bias effect, especially, among people with disabilities. Maintaining employment status among this population, and promoting their education level, should be central rehabilitation priorities.
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Affiliation(s)
- Liat Yosef
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Miki Malul
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Heine P, Sellar L, Whitten S, Bajaj P. A questionnaire-based audit to assess overall experience and convenience among patients using vaginal progesterone tablets (Lutigest ®) for luteal phase support during IVF treatment. PATIENT-RELATED OUTCOME MEASURES 2017; 8:169-179. [PMID: 29263708 PMCID: PMC5726362 DOI: 10.2147/prom.s140678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose The aim of this audit was to assess the overall experience and patient convenience of vaginal progesterone tablets (Lutigest®, marketed as Endometrin® in the USA) used for luteal phase support (LPS) during in vitro fertilization (IVF) treatment. Patients and methods This questionnaire-based audit included responses from 100 patients undergoing IVF treatment at six IVF clinics in the UK from September 2015 to November 2016. Fourteen days after starting progesterone supplementation for LPS during their IVF treatment, patients rated overall experience and perceived convenience of the prescribed progesterone by completing a questionnaire. Results Of the 100 patients included, 96 received vaginal progesterone tablets for LPS. Overall, 53.1% (51/96) indicated that the progesterone tablets were “very easy” to use; 42.7% (41/96) and 44.8% (43/96) found it “very convenient” or “neither convenient or inconvenient” to administer the tablet, respectively. Overall experience with using progesterone tablets was rated as “very comfortable” by 34.4% (33/96) and “neither comfortable or uncomfortable” by 56.3% (54/96) of patients. The applicator was used by 93.8% (90/96) of patients to administer the tablet, and 86.5% (83/96) indicated that the applicator was easy to clean for repeated use. A total of 33 patients had a previous IVF cycle during which they were prescribed vaginal progesterone pessaries for LPS. Compared with progesterone pessaries, the majority found treatment with progesterone tablets to be more comfortable (60.6%; 20/33) and more convenient (57.6%; 19/33) and indicated that the progesterone tablet was their preferred progesterone formulation for LPS (60.6%; 20/33). Conclusion These findings offer insights into real-world patient experiences with the progesterone vaginal tablet formulation. The results suggest overall patient convenience, ease, and comfort with using progesterone vaginal tablets for LPS. The majority of patients found progesterone vaginal tablets more convenient and comfortable to use compared with progesterone pessaries.
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Affiliation(s)
- Polly Heine
- Fertility Team, The Agora Gyneacology and Fertility Centre, Hove
| | - Laura Sellar
- Fertility Team, The Agora Gyneacology and Fertility Centre, Hove
| | - Sue Whitten
- Medical Affairs, Ferring Pharmaceuticals, West Drayton, UK
| | - Priti Bajaj
- Medical Affairs, Ferring Pharmaceuticals, West Drayton, UK
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Milewski R, Kuczyńska A, Stankiewicz B, Kuczyński W. How much information about embryo implantation potential is included in morphokinetic data? A prediction model based on artificial neural networks and principal component analysis. Adv Med Sci 2017; 62:202-206. [PMID: 28384614 DOI: 10.1016/j.advms.2017.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim of this study was to answer the question of how much information about embryo implantation potential can be obtained from morphokinetic parameters through the creation a predictive model based on morphokinetic information and using advanced data-mining and artificial intelligence methods. MATERIALS AND METHODS Time-lapse recordings of 610 embryos were included in the analysis. For each embryo, absolute (t2, t3, t4, t5) and relative (cc2 and s2) morphokinetic parameters were collected. Additionally, fragmentation levels assessed at t2, t3, t4 and t5 time-points, presence of multinucleation, evenness of blastomeres after the first and second division and women's age were included in the analysis. RESULTS The created predictive model of implantation was constructed on the basis of two advanced data-mining methods: principal component analysis (PCA) and artificial neural networks (ANN). The receiver operating characteristic (ROC) curve constructed for the created model demonstrated its good quality. The area under the ROC curve was AUC=0.75 with a 95% confidence interval (0.70, 0.80). Finally, the model was verified on a validation set and the results were also good, although slightly weaker: AUC=0.71, with a 95% confidence interval (0.59, 0.84). CONCLUSIONS The combination of two data-mining algorithms: PCA and ANN may be considered a method which can extract virtually all the available information from data. This methodology is indeed efficient, but models presented in the literature are also effective and close to the limit of the maximal information which can be extracted from morphokinetic data. The limit can be determined at the level of AUC value marginally above 0.7.
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Affiliation(s)
- Robert Milewski
- Department of Statistics and Medical Informatics, Medical University of Bialystok, Szpitalna 37, 15-295 Bialystok, Poland.
| | - Agnieszka Kuczyńska
- Centre for Reproductive Medicine KRIOBANK, Bialystok, Poland; Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Poland
| | | | - Waldemar Kuczyński
- Centre for Reproductive Medicine KRIOBANK, Bialystok, Poland; Department of Gynecology, Medical University of Bialystok, Poland
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